R96-70 AUTHORIZING FINAL CONVEYANCE OF HOMESTEAD PROPERTY

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-,�'" ._._.._ .._--------------- -- --- _._.____._.i..-- --- - --- ..__, ASSESSMENT INFORMATION ON SOLD PROPERTIES This page is to be completed by the County Assessor or Supervisor of Assessments. The form is to be mailed to Illinois Department of Revenue, 101 West Jefferson, P.O. Box 19033, Springfield, IL 62794-9033 after being processed by county personnel. 1. ENTER BRIEF LEGAL DESCRIPTION OF PROPERfY AS IT APPEARS ON ASSESSMENT BOOKS. 2. INSTRUCTIONS FOR COMPLETING PROPERTY DESCRIPTION CODES: I (a) Enter Permanent Real Estate Index Number. Enter the property use code in the Unit Na boxes if using the IL Real Property Appraisal Manual,or cir�le the appro- priate letter if using the codes in the Il Property Tax Manual.Enter the assessment Quadrant if applicable. (b) County&Township: Use codes from Department Code Sheets. (d) Date ot Deed: Enter month and year from Page 1 of declaration. (c) Class of Property: For Cook Counry,see Property Type Code Sheet. (e) Acreage: For Class 51 and 61 Property,enter number of acres; for Class 71 and 81 Property, leave blank. i For pownstate Counties: enter 51 (if assessed as farm(10-125)with no building) 71 (assessed as nonfarm with no building) I 61 (if assessed as farm(10-125 and 30-140)with a building) 81 (assessed as nonfarm with a building) PERMANENT REAL ESTATE INDEX NO. �a� � � � � �BL� � �PA�L� � � 1� � / F Ci�'c1e�One I� R � QUAD. � ❑ ❑ CommerKs by Supervisor of Assessmer�ts or County Assessor: (b) County Township � � ❑ (c) Ctass � � Month Year (d) Date of Deed � � � � , (e) /�creage(Round to i��a (—� ❑ nearest full acre) �J 3. ASSESSED VALUE DATA Enter assessed value as finally adjusted by the Board of Review or Appeals for the year prior to the date of sale. �hereby certify that the information shown relates Where assessment is partial or split;designate with a large"P"or"S"on the assessment boxes. YEAR PRIOR TO SAIE 19 The following questions must be answered: to the property described in the declaration and 800k Na Page �i�� Yes No 1. ❑ ❑ Is this a 14125,formery 20e,assessmerd?("Farm Bill'� that the assessed valuatio�s are for the property 2. ❑ ❑ Is this a partial auessment?(i.e,improvement not com- pleted on assessment date) included in the transfer. 3. 0 ❑ �II a split(division)be required W reflect the legal descriptbn on this deed(a Trust Document)? Dated this day of 4. 0 ❑ Has an improvement been added or rerta�ed since January 1 of the year prior W the sale,but before the sale date? , 19 , Land ❑ , ❑ ❑ ❑ . ❑ ❑ ❑ 5. ❑ ❑ �s assessment shown reflect all Board of Review a ❑ � ❑ ❑ ❑ ❑ � Appeals adion for the year indicated(induding Board Bldgs. ot Review equaliration facta►s)? ❑ � a ❑ ❑ ❑ ❑ ❑ 6. ❑ ❑ Is this a 1Q30,formery ZOg-4,assessment? Supervisor of Assessments or County Assessor ToWI 7. p ❑ If sale inwlves a mobile home,is the mobile home assessed as real estate? FOR DEPARTMENT USE ONLY ❑ ❑ Multiple Parcel Indicator Full Consideration ❑ ❑ , ❑ ❑ ❑ , ❑ ❑ ❑ Adjusted Consideration File Maintenance ❑ ❑ , ❑ ❑ ❑ , LJ ❑ ❑ TabNumber: This fortn is authorized in accordance wilh 35 I�CS 200/1-1 et seq.Disclosure of this infortnation is RE�UIRED.This fortn A SOV BASE INK Pa e 4 of 4 has been approved by the Fortns Management Center. IL-492-0227 g �i� RECYCLED PAPER PT/U(-203(R-4/94)